title: Poor post-operative growth in infants with two-ventricle physiology.
abstract: BACKGROUND
  Adequate nutritional support is essential for normal infant growth and development. Infants with congenital cardiac disease are known to be at risk for growth failure. We sought to describe perioperative growth in infants undergoing surgical repair of two-ventricle congenital cardiac disease and assess for predictors of their pattern of growth.Materials and methodsFull-term infants who underwent surgical repair of two-ventricle congenital cardiac disease at a single institution were enrolled in a retrospective cohort study performed following a larger prospective study. Infants with facial, gastrointestinal, or neurologic anomalies, trisomy chromosomal abnormality, birth weight less than 2500 grams, or those transferred to another institution before discharge home were excluded. The primary outcome was change in weight-for-age z score from surgery to discharge. Our secondary outcome variable was post-operative hospital length of stay.
  
  
  RESULTS
  A total of 76 infants met the inclusion criteria. Medain age at surgery was 5 days with a range from 1 to 44. The median weight-for-age z score at surgery was -0.2 with a range from -2.9 to 2.8 and by discharge had dropped to -1.2 with a range from -3.4 to 1.8. The median change in weight-for-age z score from surgery to discharge was -1.0 with a range from -2.3 to 0.2. Delayed post-operative nutrition (p < 0.001) and reintubation following initial post-operative extubation (p = 0.001) were associated with decrease in weight-for-age z score.
  
  
  CONCLUSIONS
  Infants undergoing repair of two-ventricle congenital cardiac disease had poor growth in the post-operative period. This may be mitigated by early initiation of post-operative nutrition.
authors.affiliation: Division of Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45255, USA. jeffrey.anderson@cchmc.org
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Anderson
authors.forename: Bradley S
authors.initials: BS
authors.lastname: Marino
authors.forename: Sharon Y
authors.initials: SY
authors.lastname: Irving
authors.forename: J Felipe
authors.initials: JF
authors.lastname: García-España
authors.forename: Chitra
authors.initials: C
authors.lastname: Ravishankar
authors.forename: Virginia A
authors.initials: VA
authors.lastname: Stallings
authors.forename: Barbara
authors.initials: B
authors.lastname: Medoff-Cooper
mesh_terms: D001724:Birth Weight; D001835:Body Weight; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006128:Growth / Q000502:physiology*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities* / Q000601:surgery; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D009752:Nutritional Status; D011184:Postoperative Period; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014463:Ultrasonography; D015430:Weight Gain